School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China.
School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China; Evidence-based Nursing Center, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China.
Arch Gerontol Geriatr. 2021 May-Jun;94:104344. doi: 10.1016/j.archger.2021.104344. Epub 2021 Jan 20.
The demands for health care services from the frail elderly individuals in the community continue to increase, which will exert a tremendous burden on health care costs. However, little is known regarding the magnitude of these impacts. In this study, we performed a systematic review and meta-analysis of the evidence to explore the impact of frailty on health care costs among community-dwelling older adults.
Relevant published articles were searched from PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Full-text Database (VIP), Wanfang Database, Chinese Biomedical Literature Database (CBM), and the reference lists of articles. Published cohort or cross-sectional studies assessing the impacts of frailty on health care costs among community-dwelling older adults were identified (to June 2020). The outcomes on health care costs before and after baseline were stratified by frailty status.
A total of 7 cohort studies comprised of a total of 3,750,611 participants were included in our study. Our analyses showed that: (1) compared with the robust group, health care costs increased by $79-13,423.83 (standardized mean difference, SMD = 0.22, 95% Confidence interval, 95% CI, 0.22-0.22; P < 0.00001) in the pre-frail elderly and by $616-32,549.96 (SMD = 0.55, 95% CI, 0.44-0.67; P < 0.00001) in the frail elderly in the community. A significantly higher in the increase of health care costs was observed in the frail group compared with the pre-frail group(SMD = 0.35, 95% CI, 0.19-0.51; P < 0.0001); (2) the frailty phenotype components increased the health care costs of the elderly in community (weight loss: $1,630-6,209, SMD = 0.43, 95% CI, 0.17-0.69; P = 0.001; weakness: $275-7,586, SMD = 0.24, 95% CI, 0.08-0.40; P = 0.001; exhaustion: $1,545-10,559, SMD = 0.31, 95% CI, 0.13-0.49; P = 0.0006; slowness: $352-1,1891, SMD = 0.40, 95% CI = 0.14-0.65; P = 0.003; low physical activity: $512-3,459, SMD = 0.26, 95% CI, 0.16-0.36; P < 0.00001); (3) the increase in the frailty index was parallel with the increase in health care costs by $12,363-21,066 (SMD = 0.41, 95% CI, 0.29-0.53; P < 0.00001).
This study revealed the adverse economic impacts of frailty status, frailty phenotype components, and frailty index on health care costs in community-dwelling older adults. Future research is warranted to investigate costs incurred by interventions to improve frailty, which will provide further insights into additional health care costs due to frailty.
社区中体弱老年人对医疗保健服务的需求持续增加，这将给医疗保健成本带来巨大负担。然而，对于这些影响的程度知之甚少。本研究通过系统回顾和荟萃分析，探讨了衰弱对社区居住的老年人医疗保健费用的影响。
从 PubMed、Embase、Web of Science、Cochrane 图书馆、中国国家知识基础设施（CNKI）、中国科技期刊全文数据库（VIP）、万方数据库、中国生物医学文献数据库（CBM）和文章参考文献中搜索了相关的已发表文章。确定了评估社区居住的老年人衰弱对医疗保健费用影响的已发表队列或横断面研究（截至 2020 年 6 月）。根据衰弱状况对基线前后的医疗保健费用结果进行分层。
共纳入 7 项队列研究，总计 3750611 名参与者。我们的分析表明：（1）与健康组相比，虚弱组的医疗保健费用增加了 79-13423.83 美元（标准化均数差，SMD=0.22，95%置信区间，95%CI，0.22-0.22；P<0.00001），脆弱组增加了 616-32549.96 美元（SMD=0.55，95%CI，0.44-0.67；P<0.00001）。与虚弱组相比，虚弱组的医疗保健费用增加更为显著（SMD=0.35，95%CI，0.19-0.51；P<0.0001）；（2）衰弱表型成分增加了社区老年人的医疗保健费用（体重减轻：1630-6209 美元，SMD=0.43，95%CI，0.17-0.69；P=0.001；虚弱：275-7586 美元，SMD=0.24，95%CI，0.08-0.40；P=0.001；疲劳：1545-10559 美元，SMD=0.31，95%CI，0.13-0.49；P=0.0006；速度减缓：352-11891 美元，SMD=0.40，95%CI，0.14-0.65；P=0.003；低体力活动：512-3459 美元，SMD=0.26，95%CI，0.16-0.36；P<0.00001）；（3）衰弱指数的增加与医疗保健费用的增加呈平行关系，增加了 12363-21066 美元（SMD=0.41，95%CI，0.29-0.53；P<0.00001）。
本研究揭示了衰弱状态、衰弱表型成分和衰弱指数对社区居住的老年人医疗保健费用的不利经济影响。未来的研究需要调查改善衰弱的干预措施所产生的成本，这将进一步了解由于衰弱而产生的额外医疗保健费用。
